MP29-20 METOIDIOPLASTY FOLLOWED BY SECONDARY PHALLOPLASTY

Abstract

INTRODUCTION AND OBJECTIVE: Metoidioplasty can be a definitive reconstruction option in transmen, but can also be an intermediate step towards phalloplasty. During the metoidioplasty, the vagina is excised (in most cases), scrotum and perineal are reconstructed, and the urethra is lengthened. As these steps have already been performed in case of prior metoidioplasty, staged phalloplasty might be associated with less urethral and flap-related complications compared to immediate (all-in-one) phalloplasty. This hypothesis was evaluated in this retrospective study. METHODS: Between 2006 and 2019, 27 patients underwent phalloplasty after prior metoidioplasty (staged phalloplasty). These patients were matched for type of flap and time period with a cohort of 27 patients who underwent immediate phalloplasty (group 2). Phalloplasty was performed with a radial forearm free flap and pedicled anterolateral thigh flap in 36 and 18 patients respectively. There were no significant differences for age, body mass index and smoking habits between both groups. Vaginectomy was performed in 23 (85%) and 20 patients (74%) in the staged and immediate phalloplasty group, respectively (p=0.31). In case of staged phalloplasty, the phalloplasty was performed after a median of 11 months (range: 4-42) after metoidioplasty. RESULTS: Median follow-up after phalloplasty was respectively 32 and 33 months for staged and immediate phalloplasty (p=0.99).For staged phalloplasty, metoidioplasty required a median operation time of 125 minutes, a median hospital stay of 5 days (range: 3-12) and a median catheter stay of 16 days. Respectively 1 (3.7%) and 2 patients (7.4%) required subsequent surgery because of respectively a perineal fistula and stricture before phalloplasty.For staged and immediate phalloplasty, median operation time was 396 and 410 minutes (p=0.6), median hospital stay was 16 and 17 days (p=0.5) with a median catheter stay of 19 and 20 days (p=0.9), respectively. In both groups, 16 patients (59%) needed at least one additional surgical procedure for postoperative complications, urethral complications (stricture, fistula) and/or flap-related complications (partial/total flap necrosis). For staged phalloplasty, additional surgery was needed because of urethral complications only, flap-related complications only, both urethral and flap-related complications, postoperative hematoma and combined urethral complications with postoperative hematoma in respectively 4 (15%), 1(3.7%), 8 (30%), 2 (7.4%) and 1 patients (3.7%), whereas this was respectively the case in 5 (19%), 3 (11%), 6 (22%), 2 (7.4%) and 0 patients who underwent immediate phalloplasty (p=0.9). CONCLUSIONS: Postoperative complications are not reduced in case metoidioplasty has been performed prior to phalloplasty. In case metoidioplasty is considered as a step towards phalloplasty, the separate morbidity of metoidioplasty must be taken into account. Source of Funding: none